Oxygen Saturation Monitoring Using Pulse Oximeter

Considerations:

• Provide student with as much privacy as possible given the urgency of the situation.
• Skin temperature may affect reading, the student’s finger should not be cold.

Supplies:

• Pulse oximeter
• Pulse oximeter probe
• Student’s Individualized Health Care Plan (IHCP) and Health care provider’s order
• Parent/Guardian authorization form
  

Procedure for Intermittent Pulse Oximetry Monitoring:

1. Review health care provider’s order/Student’s IHCP
2. Ensure proper documentation of parent/guardian authorization to perform this procedure
3. Gather supplies and place on a clean surface
4. Wash hands
5. Explain procedure to student at a level they will understand
6. Turn on pulse oximeter
7. Select a distal extremity (usually a fingertip) that can be held still and is void of nail polish, false nail, moisture, and sweat
8. Minimize excessive environmental light
   1. an accurate oxygen saturation reading requires that the pulse oximeter is able to consistently detect the student’s pulse
   1. all pulse oximeters have some form of light signal or bar graph that correlates with detecting the pulse; and a consistent high level of detection for at least 20–30 seconds is necessary to determine an accurate reading
9. Place pulse oximeter probe on distal extremity
10. Check operation of the equipment (audible beep, fluctuation of the bar of light or waveform on the face of the oximeter)
11. Make sure that the light-emitting sensor and light-receiving sensor are aligned opposite each other
12. Wait 20-30 seconds
13. Read oxygen saturation level on pulse oximeter
14. Remove pulse oximeter probe
15. Turn off pulse oximeter
16. Follow health care provider’s orders with appropriate follow up care
17. Wash hands
18. Document oxygen saturation level in student’s health care record
19. Follow up with parents/guardian and health care provider, as necessary
20. Clean pulse oximeter per manufacturer’s recommendations

Procedure for Continuous Pulse Oximetry:

1. If the pulse oximetry is indicated to be continuous, the probe needs to be secured in place per manufacturer’s instructions
2. An order for continuous pulse oximetry requires an oximeter with an alarm
3. Alarm parameters are to be set per the student’s Individualized Healthcare Plan/Health care provider’s orders
4. If the alarm sounds, the student requires immediate attention to determine if it is a “false alarm” (commonly due to excessive movement) or a true emergency that reflects a sudden deterioration in the student’s respiratory status

References:

Lynn, P. (2019). Using pulse oximeter. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach.  (5th ed.). (pp. 308-309).

Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Procedural guideline 5.2 measuring oxygen saturation (pulse oximetry). In Clinical nursing skills and techniques. (10th ed.). (pp. 216-220). St. Louis, MO: Elsevier.

U.S. Food and Drug Administration. (2021, February 19). Pulse oximeter accuracy and limitations: FDA safety communication. Retrieved June 6, 2023, from https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication

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Acknowledgment of Reviewers:

Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services

Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services

Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog

Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing
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Page last updated: February 16, 2024/no video
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